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Summary
This review examines drugs for arthritis, classifying them as NSAIDs, corticosteroids, and chondroprotectives. Newer NSAIDs show fewer negative effects on cartilage metabolism compared to older ones.
Area of Science:
- Biochemistry
- Pharmacology
- Rheumatology
Background:
- Cartilage degradation is a hallmark of arthritis.
- Understanding cartilage biology is crucial for developing effective treatments.
- Current treatments for articular disorders include NSAIDs, corticosteroids, and chondroprotective agents.
Purpose of the Study:
- To review the known biology of cartilage and its failure mechanisms in arthritis.
- To evaluate the effects of different drug classes on cartilage metabolism.
- To appraise the pros and cons of available drugs for articular disorders.
Main Methods:
- Classification of drugs into NSAIDs, corticosteroids, and chondroprotective agents.
- Examination of drug influence on cartilage metabolism using published laboratory and clinical studies.
- Review of drug properties including anti-inflammatory potency, half-life, and side effects.
Main Results:
- Not all NSAIDs are equal; newer molecules show fewer detrimental effects on cartilage metabolism than older ones.
- Tiaprofenic acid, diclofenac, and piroxicam demonstrate minimal harmful effects on cartilage at therapeutic concentrations.
- Long-acting corticosteroids may offer OA benefits but require short-term use; chondroprotective agents show in-vitro efficacy but clinical proof is challenging.
Conclusions:
- The choice of NSAIDs requires balancing cartilage effects with anti-inflammatory potency and side effects.
- Corticosteroid use in OA and RA should be limited to short durations.
- Improved clinical assessment methodologies, such as MRI and monoclonal antibodies, are needed to validate chondroprotective agent efficacy.